Measuring patient-centered communication in cancer care: a literature review and the development of a systematic approach.

Patient-centered communication (PCC) is a critical element of patient-centered care, which the Institute of Medicine (Committee on Quality of Health Care in America, 2001) promulgates as essential to improving healthcare delivery. Consequently, the US National Cancer Institute's Strategic Plan for Leading the Nation (2006) calls for assessing the delivery of PCC in cancer care. However, no comprehensive measure of PCC exists, and stakeholders continue to embrace different conceptualizations and assumptions about how to measure it. Our approach was grounded in the PCC conceptual framework presented in a recent US National Cancer Institute monograph (Epstein & Street, 2007). In this study, we developed a comprehensive inventory of domains and subdomains for PCC by reviewing relevant literature and theories, interviewing a limited number of cancer patients, and consulting experts. The resulting measurement domains are organized under the six core functions specified in the PCC conceptual framework: exchanging information, fostering healing relationships, recognizing and responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. These domains represent a promising platform for operationalizing the complicated PCC construct. Although this study focused specifically on cancer care, the PCC measurements are relevant to other clinical contexts and illnesses, given that patient-centered care is a goal across all healthcare. Finally, we discuss considerations for developing PCC measures for research, quality assessment, and surveillance purposes. United States Department of Health and Human Services, National Institutes of Health, National Cancer Institute (2006). The NCI Strategic Plan for Leading the Nation: To Eliminate the Suffering and Death Due to Cancer. NIH Publication No. 06-5773.

[1]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[2]  Smith.  The role of health professionals in informing cancer patients: findings from The Teamwork Project (phase one) , 2000, Health expectations : an international journal of public participation in health care and health policy.

[3]  H. Scott,et al.  Consumer access to health information on the internet: health policy implications , 2005, Australia and New Zealand health policy.

[4]  C. Manfredi,et al.  Factors Influencing Medical Information Seeking Among African American Cancer Patients , 2002, Journal of health communication.

[5]  Claudia Lampic, Per-Olow Sjödén.  Patient and Staff Perceptions of Cancer Patients' Psychological Concerns and Needs , 2000, Acta oncologica.

[6]  C. P. M. Vleuten,et al.  Reliability and feasibility of measuring medical interviewing skills: the revised Maastricht History‐Taking and Advice Checklist , 1991, Medical education.

[7]  Aneil Mishra,et al.  Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? , 2001, The Milbank quarterly.

[8]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[9]  Maria E Fernandez,et al.  Measures used in studies of informed decision making about cancer screening: A systematic review , 2006, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[10]  M S Davis,et al.  Variations in patients' compliance with doctors' advice: an empirical analysis of patterns o communication. , 1968, American journal of public health and the nation's health.

[11]  J. Bensing,et al.  Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. , 2000, Patient education and counseling.

[12]  R. Kravitz,et al.  When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. , 2001, The Journal of family practice.

[13]  P. Butow,et al.  Misunderstanding in cancer patients: why shoot the messenger? , 1999, Annals of oncology : official journal of the European Society for Medical Oncology.

[14]  Colin Camerer,et al.  Recent developments in modeling preferences: Uncertainty and ambiguity , 1992 .

[15]  S. Stewart,et al.  Nonadherence in Adolescent Oncology Patients: Preliminary Data on Psychological Risk Factors and Relationships to Outcome , 2004, Journal of Clinical Psychology in Medical Settings.

[16]  D. Razavi,et al.  Being known: patients' perspectives of the dynamics of human connection in cancer care , 2005 .

[17]  P. Bower,et al.  Measuring patient-centredness: a comparison of three observation-based instruments. , 2000, Patient education and counseling.

[18]  D. Easter,et al.  Disclosing and responding to cancer "fears" during oncology interviews. , 2005, Social science & medicine.

[19]  J A Sloan,et al.  The Control Preferences Scale. , 1997, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[20]  Ronald M Epstein,et al.  Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. , 2009, JAMA.

[21]  M. Hall.  Do patients trust their doctors? Does it matter? , 2001, North Carolina medical journal.

[22]  L. Fallowfield,et al.  Psychiatric morbidity and its recognition by doctors in patients with cancer , 2001, British Journal of Cancer.

[23]  Paul K J Han,et al.  Communicating the Uncertainty of Harms and Benefits of Medical Interventions , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[24]  Sallie Newell,et al.  How well do Medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? , 1998, Cancer.

[25]  R. Street.  Analyzing Communication in Medical Consultations: Do Behavioral Measures Correspond to Patients' Perceptions? , 1992, Medical care.

[26]  E. Deci,et al.  Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. , 2004, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[27]  R. Glasgow,et al.  Assessing delivery of the five 'As' for patient-centered counseling. , 2006, Health promotion international.

[28]  F. Lang,et al.  Clues to patients' explanations and concerns about their illnesses. A call for active listening. , 2000, Archives of family medicine.

[29]  Jeanne Keruly,et al.  Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? , 2006, Journal of general internal medicine.

[30]  Ellen Peters,et al.  Beyond information: exploring patients' preferences. , 2009, JAMA.

[31]  Sabrina T. Wong,et al.  Shared Decision Making and the Experience of Partnership in Primary Care , 2006, The Annals of Family Medicine.

[32]  Richard L. Street,et al.  Patient-centered communication in cancer care: Promoting healing and reducing suffering , 2007 .

[33]  R. Epstein,et al.  Facilitating patient-centered cancer communication: a road map. , 2009, Patient education and counseling.

[34]  M. Somerfield,et al.  Can 40 seconds of compassion reduce patient anxiety? , 1999, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[35]  R. Bales.  Interaction process analysis; a method for the study of small groups. , 2013 .

[36]  S L Rosenkranz,et al.  The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction. , 2000, Patient education and counseling.

[37]  R. Street,et al.  Analyzing Patient Participation in Medical Encounters , 2001, Health communication.

[38]  R. Brienza,et al.  A method to quantify and compare clinicians' assessments of patient understanding during counseling of standardized patients. , 2009, Patient education and counseling.

[39]  Kirsti Kvåle,et al.  Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. , 2007, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[40]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[41]  Charles R. Berger,et al.  The handbook of communication science , 1987 .

[42]  G. Watt,et al.  Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice. , 2005, Family practice.

[43]  R. Epstein,et al.  Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues. , 2005, Social science & medicine.

[44]  L. Siminoff,et al.  Measuring discord in treatment decision‐making; progress toward development of a cancer communication and decision‐making assessment tool , 2006, Psycho-oncology.

[45]  Janet L. Stewart,et al.  Benefits from an uncertainty management intervention for African–American and Caucasian older long‐term breast cancer survivors , 2005, Psycho-oncology.

[46]  Katherine Treiman,et al.  Cancer Patients' Information Needs across the Cancer Care Continuum: Evidence from the Cancer Information Service , 2005, Journal of health communication.

[47]  J. Griggs,et al.  Stability of decisional role preference over the course of cancer therapy , 2006, Psycho-oncology.

[48]  M. Mazzi,et al.  A theory‐based proposal to evaluate patient‐centred communication in medical consultations: The Verona Patient‐centred Communication Evaluation scale (VR‐COPE) , 2008 .

[49]  J. Mandelblatt,et al.  Patient navigation: State of the art or is it science? , 2008, Cancer.

[50]  Information for patients with early-stage prostate cancer: a comparison of professionals' attitudes in Canada and Italy , 2003, Supportive Care in Cancer.

[51]  J. Brown.  Patient-centred medicine: Transforming the clinical method , 1998 .

[52]  H. Waitzkin.  Information giving in medical care. , 1985, Journal of health and social behavior.

[53]  R. Street.  Physicians' communication and parents' evaluations of pediatric consultations. , 1991, Medical care.

[54]  S Kreitler,et al.  Doctor-patient communication in a cancer ward. , 1992, Journal of cancer education : the official journal of the American Association for Cancer Education.

[55]  S. Harris,et al.  ‘Being known’: patients' perspectives of the dynamics of human connection in cancer care , 2005, Psycho-oncology.

[56]  M. Stewart.  Towards a global definition of patient centred care , 2001, BMJ : British Medical Journal.

[57]  P. A. Kelly,et al.  Racial differences in trust and lung cancer patients' perceptions of physician communication. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[58]  R. Rimal.  Analyzing the Physician-Patient Interaction: An Overview of Six Methods and Future Research Directions , 2001, Health communication.

[59]  M. Stewart,et al.  Breast cancer patients' experiences of patient-doctor communication: a working relationship. , 2000, Patient education and counseling.

[60]  D. Roter,et al.  The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions. , 2002, Patient education and counseling.

[61]  R. Epstein,et al.  Recall-Promoting Physician Behaviors in Primary Care , 2008, Journal of General Internal Medicine.

[62]  P. Butow,et al.  The dynamics of change: cancer patients' preferences for information, involvement and support. , 1997, Annals of oncology : official journal of the European Society for Medical Oncology.

[63]  F. Oort,et al.  Medical Specialists’ Patient-Centered Communication and Patient-Reported Outcomes , 2007, Medical care.

[64]  R. Grol,et al.  Problems to discuss with cancer patients in palliative care: a comprehensive approach. , 2002, Patient education and counseling.

[65]  R. Epstein,et al.  Ratings of Physician Communication by Real and Standardized Patients , 2007, The Annals of Family Medicine.

[66]  J. Galassi,et al.  The Patient Reactions Assessment : a brief measure of the quality of the patient-provider medical relationship , 1992 .

[67]  W. Stiles,et al.  Verbal exchanges in medical interviews: concepts and measurement. , 1992, Social science & medicine.

[68]  R. Gray,et al.  Patient-health care provider communication during chemotherapy treatment: the perspectives of women with breast cancer. , 2001, Patient education and counseling.

[69]  R. Frankel,et al.  Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II Report , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[70]  Interpersonal Dimensions of Health Communication , 2010 .

[71]  W. Levinson,et al.  A study of patient clues and physician responses in primary care and surgical settings. , 2000, JAMA.

[72]  P. Jacobsen,et al.  Screening for psychological distress in cancer patients: challenges and opportunities. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[73]  P. Slovic.  The Construction of Preference , 1995 .

[74]  P. Haidet,et al.  Understanding Concordance in Patient-Physician Relationships: Personal and Ethnic Dimensions of Shared Identity , 2008, The Annals of Family Medicine.

[75]  Jürgen Kasper,et al.  Decision‐related uncertainties perceived by people with cancer—modelling the subject of shared decision making , 2008, Psycho-oncology.

[76]  R. Henriksson,et al.  Severely diseased lung cancer patients narrate the importance of being included in a helping relationship. , 2005, Lung cancer.

[77]  Paul K J Han,et al.  Perceived Ambiguity About Cancer Prevention Recommendations: Relationship to Perceptions of Cancer Preventability, Risk, and Worry , 2006, Journal of health communication.

[78]  P. Butow,et al.  Audiotapes of oncology consultations: only for the first consultation? , 2002, Annals of oncology : official journal of the European Society for Medical Oncology.

[79]  William B Stiles,et al.  Description versus evaluation of medical interviews , 2002, Epidemiology and Psychiatric Sciences.